The main danger, if you can call it that, is that
either you won't be able to live long enough to get the call, or when you
do get transplanted, you will be too sick to withstand the physical trauma
of the operation. Why? Because late referrals are the single
largest cause of transplant failure. The best hedge against this
is to get listed as soon as possible at more than one transplant center.

Of course, there is risk associated with any procedure
that requires anesthetic, as is often said, but in this procedure there
is the additional risk of being put on a cardio-pulmonary bypass machine.
In some cases, extra blood may be needed, so there is also be the risk
associated with getting a blood transfusion to contend with. Hey,
you asked.

But generally speaking, there is no more risk than
that of any other major surgery, such as a heart bypass, for example.
In fact, a lung transplant may arguably be safer from an operational standpoint
than a heart bypass--the plumbing is simpler, and the incision is easier
to deal with. Of course, after the operation is where the fun begins,
specifically with respect to complications related to the procedure, such
graft problems, CMV infection, organ rejection, and the like. It
is a measure of the talent of the transplant staff how well they anticipate
and then prophylactically treat for problems commonly associated a lung
transplant. Even details as seemingly insignificant as the careful
and continual adjustment of electrolyte levels such as sodium, potassium,
and magnesium are absolutely essential to a successful recovery.
Again, there is no substitute for talent.

Danger also resides in the ability (or lack of
ability) of the patient to adhere to a strict schedule of medication and
regularly scheduled appointments. In the first month after hospitalization
expect to have to be seen twice a week, and give blood at least as often,
as well as have numerous X-Rays taken. Add to that the daily intravenous
infusions of Gancyclovir to prevent CMV infection, which will require a
Hickman Catheter and all of the cleaning and/or maintenance associated
with that. You get used to it, though, believe me. Then there
are the initial surveillance bronchoscopies and then mandatory follow-up
bronchoscopies every quarter. In the second year, these are done
bi-annually, and annually in years after that. So if you decide to
skip any of these important safeguards, you are inviting dangerous consequences.

What other dangers are there? Poorly administered
or mishandled medications can upset the body's recovery. Failure
to exercise properly can inhibit recovery. Infections contracted
in the hospital such as aspergillus, usually treated prophylactically with
Amphoteracin-B, can be a bear--as my post-transplant coordinator Roberto
used to say, "aspergillus is ubiquitous". Having a kitten scratch
you after defecating in the litter box and you subsequently contracting
toxoplasmosis can be a real bummer. Friends with kids in daycare
that get every bug in the book and then come in your house and shake your
hand without first washing theirs can be a nuisance. A backed-up
mid-line catheter that blocks proper infusion of the anesthetic during
a surveillance bronchoscopy can be a real eye-opener. Driving a car
before the sternum heals properly can become a setback. I could go
on.

Should any of this dissuade you from obtaining
a transplant? Does the risk of being in an accident stop you from
driving? Did the risk of getting cancer stop you from smoking (if
you smoked)? All right, then.